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occurred during the operation due to injury to the horizontal portion of the facial canal which formed the upper rim of the fistula.
After the operation the pain subsided. The paralysis gradually passed off and the diplopia entirely disappeared in four weeks. The slight facial paralysis passed off within a week. The discharge and dizziness soon disappeared. The middle ear was grafted five weeks later, the posterior wound closed and the patient made a good recovery. The peculiar features of this case are:
(1) The involvement of the internal ear early in the course of an acute suppurative otitis media.
(2) The avenue of infection was through the oval window.
(3) The cause of the abducens paralysis by extension of the infection to the nerve sheath through the labyrinth seems probable on account of its rapid subsidence after drainage of the labyrinth was established.
(4) The prompt recovery after drainage was established suggests that it was not necessary to remove the inner tympanic wall and completely curet the inner ear.
(5) The conclusion seems reasonable that the occurrence of abducens paralysis in acute suppurative otitis media means an inward invasion of the infection, and when accompanied by the above mentioned symptoms operative rather than palliative treatment should be applied to the tympanic cavity.
R. B. C.
BY WILLIS SIDNEY ANDERSON, M. D., Detroit, MICHIGAN.
ASSISTANT TO THE CHAIR OF LARYNGOLOGY IN THE DETROIT COLLEGE OF MEDICINE
THE ETIOLOGY AND TREATMENT OF MYCOSIS OCCURRING IN THE UPPER RESPIRATORY TRACT.
UNDER the above title, Doctor John Sendziak, of Warsaw (Annals of Otology, Rhinology and Laryngology, December, 1905), gives an exhaustive review of the subject. He states that the following are the particular varieties of mycoses met with in the upper respiratory
(1) Mycosis leptothricia: causative agent-leptothrix bacillus. (2) Mycosis sarcinica: causative agent-a variety of the sarcina. (3) Actinomycosis: the causative agent being the actinomyces. (4) Mycosis aspergillosis: caused by various kinds of aspergillus. (5) Mycosis mucorina: produced by certain varieties of mucor. This, according to some authors, causing the so-called "black-tongue." (6) Mycosis oidica (soor): caused by the oidium albicans. The etiology of mycosis leptothricia has not been positively decided. There exists two principal theories: (a) The parasitic, and (b) the chemical theory. The advocates of the first theory believe that the
causative agent is the leptothrix bacillus, while those who believe in the second theory hold that the organism is merely incidental to chemical changes in the secretions.
Mycosis leptothricia is relatively more frequent in females than in males. It shows itself in the form of pearly white, hard tufts or spots which are situated in the crypts of the faucial tonsils, the lingual tonsils, and sometimes seen in the follicles of the posterior pharyngeal wall. These tufts are strongly adherent to the adjacent tissue and are removed with difficulty, leaving a bleeding surface.
The course of the disease is chronic, and the symptoms may be few, or none at all. The most common symptoms are a scratching, pricking, burning sensation in the throat, accompanied by a disagreeable sensation of stiffness and fullness.
The most satisfactory treatment is the thorough use of the curet or the galvanocautery to eradicate the disease. General tonics should be given.
Mycosis sarcinica occurs in the upper respiratory tract on the mucous membranes of the oral cavity in persons who suffer from diseases of the lungs, pneumonia, bronchiectasis, gangrene, and especially in persons suffering from tuberculosis or typhoid. This parasite is found on the mucous membrane of the tongue, as well as on the soft palate, in whitish diffuse masses similar to mould. This form of mycosis is of no special importance, and general symptoms are lacking.
Actinomycosis is more frequent in men than in women, and usually runs a chronic course. The disease is common in cattle, and may be transferred directly to man. The symptoms of actinomycosis of the upper respiratory tract consist, in general, of very violent pains in the region of the pathologic process. The disease is primarily located in the oral cavity, on the alveolar process of the lower jaw, causing periostitis alveolaris. It may extend to the pharynx, producing great swelling in the palatopharyngeal region, with whitish-yellow nodules identical in appearance to follicular abscess.
The prognosis is not favorable, especially if the internal organs become affected by the metastatic processes.
The treatment of actinomycosis of the upper respiratory tract is primarily surgical in nature. Iodid of potassium internally seems to do good.
Mycosis aspergillina in the upper respiratory tract is rarely seen The cause of this is undoubtedly due to the peculiarity of these organs. Persons working in tanneries, or those dealing in leather, are predisposed to this disease, as leather is an excellent medium in which the development of the aspergillus occurs.
Mycosis mucorina in the upper respiratory tract occurs but rarely. It appears in two forms: (a) Mycosis dependent on the mucor corymbifer, and (b) mycosis depending on the mucor niger-the more usual form. The second form, the so-called "black-tongue," is not a rare.
condition. The clinical picture is a brown discoloration, or a hairyblack condition on the posterior part of the papillæ circumvallatæ.
The treatment consists in the scraping away of the hairy material, as well as the use of alkaline gargles.
Mycosis oidica (soor, thrush) occurs usually in young children. The infection takes place from ingested objects, from nipples, and less frequently from the air, or the infection takes place through the phenomenon of partus. Thrush occurs as small, round, white spots, with small excavations in the center, easily removable at first, later, as the disease progresses, more adherent. These spots coalesce irregularly, forming a sort of membrane of dirty color, the underlying mucous membrane being red and swollen.
Local cleanliness and general treatment is indicated in this disease.
BY WILLIAM FLEMING BREAKEY, M. D., ANN ARBOR, MICHIGAN.
CLINICAL PROFESSOR OF DERMATOLOGY AND SYPHILOLOGY IN The university of MICHIGAN.
JAMES FLEMING BREAKEY, M. D., ANN ARBOR, MICHIGAN.
ASSISTANT IN DERMATOLOGY IN THE University of MICHIGAN.
SPIROCHETA PALLIDA (SPIRONEMA PALLIDUM) IN
THE Lancet of March 10 contains a symposium on the spirochætæ. The first article under the above title is concluded in the issue of March 17. In this, Theodore Shennan goes into the history and literature of the search for the contagium of syphilis from the time of the sixteenth century. His search of the literature on the spirochætæ has been thorough. He records the works of Schaudinn and Hoffmann, and describes the spirochata pallida and spirochæta refringens, methods of staining and differentiating.
Spirochæta pallida has been found in surface lesions, indolent buboes, in blood obtained by splenic puncture, in circulating blood in secondary syphilis and in various lesions of the inherent syphilitic. Levaditi considers congenital syphilis to be a spirillosis of the newly born. Efforts to find the spirochæta pallida in tertiary lesions have, with rare exceptions, proved unsuccessful. In searching for spirochætæ numerous preparations should be made owing to their unequal and irregular distribution.
Kiolomenoglou and von Cube found and demonstrated various forms of spirochætæ in nonspecific lesions. Hoffmann admitted their great similarity but claimed that they could be morphologically or tinctorially distinguished from the pallida. Hoffmann states that those found in carcinomata have blunt ends.
Kraus and Prantschoff found that spirochætæ disappear from excised tissues within six hours. This is interesting in view of the
generally accepted clinical fact that syphilitic virus removed from the body soon degenerates.
Levaditi and Petresco found spirochætæ readily and in considerable numbers in the serum of induced blisters.
Rona found the spirochata pallida in six out of twenty healthy women and in three out of eighteen healthy men. reported by others.
Similar results are
The syphilitic virus cannot pass through a porcelain filter. Statistics of the findings of numerous authors are given. Schaudinn found spirochæta pallida constantly in seventy cases and in tertiary lesions as granular resting forms.
Castellani and Wellman have found spihochætæ in yaws corresponding closely to the spirochæta pallida.
Various spirochetæ often much resembling the spirochata pallida have been found in hospital gangrene, in noma, gangrenous tonsillitis, vaccine pustule, carcinomata and various venereal and nonvenereal conditions and in the bone marrow and muscular coat of the small intestine from cases of severe anemias and carcinomatous lymphangitis. These various spirochætæ, as a rule, may be differentiated by staining. Attempts at cultivation have so far been unsuccessful.
BY DAVID INGLIS, M. D., DETROIT, MICHIGAN.
J. F. B.
PROFESSOR OF NERVOUS AND MENTAL DISEASES IN THE DETROIT COLLEGE OF MEDICINE.
IRWIN HOFFMAN NEFF, M. D., PONTIAC, MICHIGAN.
ASSISTANT PHYSICIAN AT THE EASTERN MICHIGAN ASYLUM.
"THE MENTAL SYMPTOMS OF CEREBRAL TUMOR."
DOCTOR PHILLIPS COOMBS KNAPP cites (Boston Medical and Surgical Journal, April 5, 1906) the opinion of others on the relation and frequency of mental symptoms in brain tumors, and gives his statistics, which have proved to him that in ninety per cent of all cases of brain tumor mental symptoms can be noted. He reiterates his statement made some years ago that in every case some mental change can be found by a competent observer who has known the patient before. In other words: there can be no gross lesion in the brain without some disturbance, greater or less, in the physical functions. He, however, modifies the dictum to this effect: that in every case of brain tumor some mental symptoms can properly be discovered, at least by a competent observer who has known the patient intimately before. Regarding the nature of the mental symptoms, Knapp says that his investigations agree with those of Schuster. Schuster's statistics are dependent upon a series of seven hundred seventy-five collected cases, and would indicate that
while mental torpor and stupor are present in a greater proportion of cases, specific psychoses are not infrequently found. Thus of his seven hundred seventy-five collected cases, two hundred fifteen showed mental conditions analogous to recognized forms of mental trouble. The question of the relation of the seat of the tumor and the mental symptoms is given considerable space by the author. The statistics of collaborators are considered and a reference table comprising all of the author's cases is given.
In conclusion he states that "in studying the early development of mental symptoms I have already indicated the relative importance of certain areas in the possible production of such symptoms; but the fact that mental symptoms may arise from a growth anywhere within the cranium, forces upon us the conclusion that other factors beside the location are of importance in their production." Knapp is unable to find any relation between the nature of the growth and the form of mental disturbance. He believes, however, that a rapidly growing tumor will more speedily cause mental symptoms than one of slow growth. He also infers from his study that "delirious" conditions are more apt to occur in cases of sarcoma. Attention is called to the resemblance between the mental symptoms met with in cases of brain tumors to those occurring in toxic psychoses.
The writer believes that the cases under consideration reveal nothing as to the nature or even the existence of these toxins, but it seems probable that while the situation of the growth is often of influence in producing mental symptoms, especially in the early stages of the disease, and possibly has an influence upon the nature of the symptoms, a combination of increased cranial pressure and the action of the toxin are of greater importance, and in some cases may be the only factor to be considered in the production of such symptoms.
I. H. N.
BY DELOS LEONARD PARKER, PH. B., M. D., DETROIT, MICHIGAN.
LECTURER ON MATERIA MEDICA IN THE DETROIT COLLEGE OF MEDICINE.
THE THERAPEUTICS OF LUPULIN.
DOCTOR THOMAS F. REILLY (The Journal of the American Medical Association, April 7, 1906) discusses the therapeutics of lupulin as brought out by an investigation made by himself and H. Stern, M. D., of New York. At the outset the statement is made that the purpose of the paper is to bring into view some of the old, and also some of the new, properties of one of the oldest agents in the materia medica.
Attention is called to the circumstance that formerly lupulin was looked upon as almost a specific for scrofula, struma and the various. skin diseases.